Tuberculosis (TB) in Children

What is tuberculosis?

Tuberculosis (TB) is a chronic infection caused by bacteria. It usually infects the
lungs, although other organs such as the kidneys, spine, or brain are sometimes involved.
TB is primarily spread through droplets breathed or coughed into the air.

There is a difference between being infected with the TB bacterium and having active
disease.

There are 3 important ways to describe the stages of TB. They are as follows:

Exposure. This occurs when a person has been in contact with, or exposed to, another person
who is thought to have or does have TB. The exposed person will have a negative skin
test, a normal chest X-ray, and no symptoms of the disease.

Latent TB infection. This occurs when a person has TB bacteria in his or her body, but does not have symptoms
of the disease. The infected person's immune system walls off the TB organisms and
they remain dormant throughout life in most people who are infected. This person would
have a positive skin test but a normal chest X-ray and can't spread the infection
to others.

TB disease. This describes the person who has signs and symptoms of an active infection. This
person would have a positive skin test and a positive chest X-ray and can spread the
disease if untreated or precautions are not in place.

The main bacterium that causes TB is Mycobacterium tuberculosis (M. tuberculosis). Many people infected with M. tuberculosis never develop active TB and remain in the latent TB stage. However, in people with
weak immune systems, including those with HIV (human immunodeficiency virus) or diabetes,
and those who are treated with medicines that can weaken the immune system, such as
corticosteroids and chemotherapy, TB organisms can overcome the body's defenses, multiply,
and cause an active disease. Very young children are more likely than older children
and adults to have TB spread through their bloodstream and cause complications, such
as meningitis.

Who is at risk for developing TB?

TB affects all ages, races, income levels, and both genders. Those at higher risk
include the following:

People who live or work with others who have TB

People without access to good healthcare

Homeless people

People from other countries where TB is prevalent

People in group settings, such as nursing homes

People who abuse alcohol

People who use intravenous drugs

People with weak immune systems

The elderly

Healthcare workers who come in contact with high-risk populations

What are the symptoms of TB?

Different symptoms of TB are present depending on the age of the child affected. The
following are the most common symptoms of active TB:

In children:

Fever

Unintended weight loss

Poor growth

Sweating at night

Cough

Swollen glands

Chills

In adolescents:

Cough that lasts longer than 3 weeks

Productive cough

Pain in the chest

Blood in their sputum

Weakness and fatigue

Swollen glands

Unintended weight loss

Decrease in appetite

Fever

Chills or night sweats

The symptoms of TB may look like other lung conditions or medical problems. Always
see your child's doctor for a diagnosis.

What causes TB?

The TB bacterium is spread through the air when an infected person coughs, sneezes,
speaks, sings, or laughs. Repeated exposure to the germs is usually necessary before
a person will become infected. It is not likely to be spread through personal items,
such as clothing, bedding, a drinking glass, eating utensils, a handshake, a toilet,
or other items that a person with TB has touched. Good air flow is the most important
measure to prevent the spread of TB.

How is TB diagnosed?

TB is diagnosed with a TB skin test. In this test, a small amount of testing material
is injected into the top layer of the skin. If a certain size bump develops within
2 or 3 days, the test may be positive for TB infection. Additional tests to determine
if a child has TB disease include X-rays and sputum tests. There are also blood tests
called interferon-gamma release assays (IGRA) that can aid in diagnosis.

TB skin tests are suggested for those:

In high-risk categories.

Who live or work in close contact with people who are at high risk.

Who have never had a TB skin test.

For skin testing in children, the American Academy of Pediatrics recommends:

Immediate testing:

If the child is thought to have been exposed in the last 5 years.

If the child has an X-ray that looks like TB.

If the child has any symptoms of TB.

If the child comes from a country where TB is prevalent.

Yearly skin testing:

For children with HIV.

For children who are in detention facilities.

Testing every 2 to 3 years:

For children who are exposed to high-risk people.

Consider testing in children from ages 4 to 6 and 11 to 16:

If the child's parent has come from a high-risk country.

If the child has traveled to high-risk areas.

If the child lives in a densely-populated area.

What is the treatment for tuberculosis?

Treatment may include:

Short-term hospitalization

Medicine

For latent TB in children ages 2 to 11. Usually a 6 to 12-month course of isoniazid
will be given to kill off the TB organisms in the body. Other, shorter regimens are
also available.

For active TB in children. Doctors may prescribe 3 to 4 medicines at once for up to
6 months or more for the medicine to be effective.

Children usually start to improve within a few weeks of the start of treatment. After 2
weeks of treatment with the correct medicines, the child is not usually contagious,
provided that treatment is carried through to the end, as prescribed by a doctor.
It is important to take all the medicines for the entire period prescribed.